In January 2008 the leader of Hampshire Council, councillor Ken Thornber, announced a commission of inquiry into the future services for adults needing support and care. The commission brought together various experts and considered a range of evidence and opinion to determine how a new system of care and support should look.

Objectives

Following the publication of Putting People First in December 2007, and the stated commitment to transforming care services by 2011, Hampshire Council decided to establish a commission to address the personalisation agenda proactively and to identify ways of tackling the unfairness and unsustainability of the social care system.

Findings and Analysis

The ambition of the Hampshire Commission was apparent, and while many other councils were no doubt considering how best they should respond to the new agenda set by Putting People First, the decision by Hampshire to choose the particular approach that they did raises several issues. The report of the inquiry is in some respects a curious hybrid. The inquiry offers national recommendations and a “Hampshire model” for local implementation.

The national recommendations (see box) address many of the issues that other bodies have also tackled – notably the Commission for Social Care Inspection in its recent review of eligibility criteria. However, many will feel there is an element of swagger in a single council setting itself up as an appropriate body to make national recommendations on the future of social care on the basis of its local commission. There are major democratic issues raised by such a development.

No doubt the report should be considered as part of the response to the government’s consultation on the future of adult social care, but many will feel that national recommendations are properly the business of bodies with a wider representative remit and accountability. Indeed, the evidence base developed by the inquiry is relatively slight for a “national inquiry”, attracting submissions from:

● 132 members of the public

● 36 organisations

● 27 members of local authority staff

This should be compared, for example, with the CSCI eligibility review which attracted almost 3,000 responses to an online survey, and almost 100 written documents from interested organisations and other parties. This is not to argue that the Hampshire findings are wrong, but merely to point out that the self-styled national remit of the inquiry lacks some weight or obvious mandate.

So far, so familiar – at the level of principle few of the broad recommendations of the Hampshire Commission offer any great surprise or innovation and many appear to do little more than restate those already proposed by the CSCI. It is nonetheless worth examining in some detail the implications of the recommendations for national implementation. What needs to happen to deliver the vision of personalisation in adult social care to which Hampshire, and just about everyone else, are signed up?

Fair access to care

The issues connected with eligibility criteria have been explored in great detail by the CSCI, and the Hampshire Commission acknowledged that its recommendations support the findings of the CSCI review with the emphasis on the urgency of response required being the key criterion for eligibility.

It is surprising, therefore, that on the basis of this analysis the Hampshire Commission recommends retaining the system of Fair Access to Care (Facs), and argues that “the new system needs to start with what we have now.” Even if mitigated by the universal offer of advice, information and supported self-assessment for everyone, this seems a surprising conclusion and retaining the current Facs model “to ensure stability and affordability” appears flawed. It is difficult to understand how this position is compatible with the avowed support for the “priorities for intervention” approach which has been offered by CSCI as an alternative – and fairer – model to Facs.

The Hampshire Commission recommendation that there should be a single resource allocation system (RAS) is another that reiterates recommendations made by the CSCI. The CSCI review highlighted concerns over the variability of different funding formulae, and the associated lack of equity and portability, but acknowledged the need for some local variation in values attached to price points in order to accommodate differentials in the cost of developing and providing local services. Indeed, the Hampshire inquiry supported the case for a national RAS and saw it as the opportunity to transform the current charging system for social care. Rather than levying charges, the RAS could offer a model for “co-payment” whereby the net value of the RAS would be reduced depending on the means of the individual, as the report explains:

“The impact of this is that rather than raising a charge on a person for social care depending on their wealth, they would have a reducing allocation of local authority funding which might be zero if their resources are above the revised disregard threshold.”

The attractions of this model, in terms of savings in bureaucracy and administrative costs are obvious. Moreover, this also offers the benefits of simplicity and transparency, and if followed as a national model would offer an equitable solution to the recurrent bugbear of unfair variation.

Workforce role

Many of the Hampshire recommendations – such as on joint working, market development and the involvement of people who use services – are matters that require local action and initiative. However, questions about the role of the workforce also have major implications for national policy.

It is puzzling that, while directing recommendations towards the Association of Directors of Adult Social Services, Skills for Care and the Department of Health on workforce issues, the Hampshire inquiry did not include the workforce regulator – the General Social Care Council – within its scope, or indeed even mention it anywhere in the report. This is all the more surprising when the inquiry recommended there should be exploration of a national voluntary accreditation scheme for personal assistants/careworkers.

The GSCC announced in June 2008 that it intends to consult widely on whether there is support for the regulation of personal assistants, and it is unfortunate that the inquiry appeared unaware of this development. The lack of acknowledgement of the existence of the newly established Skills Academy for Social Care is another omission, and any approach to developing the skills of individual care workers and the career pathways open to them must be approached through this route. The Hampshire Commission is right to emphasise the importance of training (and financial support for training) flexible career pathways recruitment and retention, but it is wrong to assume – as it appears to do – that these issues are not on the agendas of the appropriate agencies.

The report provides further helpful material to inform the national debate around the future of adult social care, and will no doubt be considered in detail along with all other submissions to the government’s consultation leading to the much anticipated adult social care green paper in the spring. Whether it brings anything unique or distinctive to that analysis is less clear, and for Hampshire Council the added value of conducting this inquiry must be a matter for debate.

Hampshire proposals

● The Universal Offer: the government should set out a Universal Offer for adult social care that is widely publicised so that people are aware of their entitlements.

● Free urgent care: for people at risk of admission to hospital or being discharged and needing urgent social care, all care should be free for up to eight weeks.

● Savings disregard: should be raised from £22,250 to £50,000.

● The legal framework: the Law Commission should take full account of the transformation of personalised health care support in its review of social care legislation.

● The retention of Fair Access to Care: FACS should remain in a transition period to ensure stability and affordability, but with modifications.

● Resource allocation system: a national RAS should be developed to provide a consistent and portable framework for allocating resources.

● Benefits: the government should review the relationship between eligibility and the tax and benefit systems.

● Joint working: public services should invest in early intervention and prevention.

● User involvement: service users and their organisation should be centrally involved in running and developing personalisation and self-directed support.

● Carers: the government should support carers in recognition of the care they provide, and should remove the overlapping benefits rule.

● Market and infrastructure: national work is required to clarify the roles of advocacy, brokerage and support planning.

● Risk quality and outcomes: the new regulatory framework for health and social care must embrace the key values and principles of personalisation.

● Workforce: Adass, Skills for Care and Department of Health should explore a national voluntary accreditation scheme for personal assistants/careworkers.

● Place shaping and community capacity: a duty should be placed on public services to take account of the needs of disabled people, and the connections between independent living, place shaping and personalisation should be recognised and be complementary.

Melanie Henwood is an independent health and social care consultant and vice chair of the GSCC

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